Individual
MR. BURTON HENRY SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SLP
Contact information
Practice address
11332 CLAYRIDGE DR, TAMPA, FL 33635-1558
(813) 818-0910
Mailing address
11332 CLAYRIDGE DR, TAMPA, FL 33635-1558
(813) 818-0910
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA 1991
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8808121
—
FL
Enumeration date
02/28/2007
Last updated
07/08/2007
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